Policy, Systems, and Environmental Change

For health promotion and disease prevention strategies to be successful, policies, systems, and environments
(PSE) must be supportive of health. Policy, systems, and
environmental change strategies are designed to promote healthy behaviors by making healthy choices
readily available and easily accessible in the community. PSE change strategies are designed with sustainability
in mind.

Policy Change

Policy is a tool for achieving health promotion
and disease prevention program goals. Policy decisions are made by organizations, agencies, and stakeholders.
Policy approaches include legislative advocacy, fiscal measures, taxation, and regulatory oversight. Examples of
health promotion and disease prevention policy approaches include:

Establishing policies for smoke-free zones and public events

Establishing healthy food options in vending machines in public places

Adding a tax to unhealthy food options

Requiring the use of safety equipment in a work setting to avoid injury

State and local governments often implement policy interventions for rural tobacco prevention and control.
Models for state and local governments are available in the Rural
Tobacco Control and Prevention Toolkit. Additional considerations for implementing rural health policy
are available in the Rural Health Policy topic guide.

Systems Change

Systems change refers to a fundamental shift in the way problems are solved. Within an organization, systems
change affects organizational purpose, function, and connections by addressing organizational culture, beliefs,
relationships, policies, and goals. Examples of systems change in health promotion and disease prevention
include:

Developing plans for implementing new interventions and processes

Adapting or replicating a proven health promotion model

Implementing new technologies

Creating training or certification systems that align with policies

Environmental Change

Environmental change strategies involve changing the economic, social, or physical surroundings or contexts that
affect health outcomes. Environmental strategies address population health outcomes and are best used in
combination with other strategies. Examples of environmental strategies for health promotion and disease
prevention include:

Increasing the number of parks, greenways, and trails in the community

Installing signs that promote use of walking and biking paths

Increasing the availability of fresh, healthy foods in schools, restaurants, and cafeterias

Examples of PSE Change Interventions

The Albert Lea Blue Zones Project implements PSE changes to increase
walking and biking in their rural community. Activities include a public education campaign, organizing
social groups for walking and biking, and improving public spaces.

Kentucky Homeplace is a community health worker (CHW) initiative that
addresses health through PSE changes. The initiative emphasizes care coordination and health coaching for
diabetes, hypertension, and tobacco cessation, among other health topics. CHWs provide health information,
screenings, and health coaching. The initiative also supports reduced or no-cost services and medications.

Healthy Adams County is an organization created by community members in
rural Pennsylvania. The organization includes community task forces such as the Breast Cancer Coalition,
Food Policy Council, Behavioral Health, Health Literacy, Oral Health, and Tobacco Prevention, among others.
Activities are implemented to drive PSE changes in the community.

In Ohio, School as a Hub for Health, a project of the Athens Creating
Healthy Communities Coalition, implements PSE changes within schools with the goal of achieving improvements
in physical, mental, and social health. Examples of the services offered through the program include healthy
vending machine options; dental sealants; integrated mental health services; and school-based gardens, food
pantry, and community health clinics.

Considerations for Implementation

PSE change strategies have the potential to create positive changes in different settings. PSE change strategies
are often complex, as they attempt to drive change at multiple levels (for example, within an organization,
community, or state). PSE change strategies are therefore useful in addressing chronic diseases and other
complex health problems, such as obesity and diabetes.

Programs seeking to implement PSE change strategies must have realistic expectations about the time and barriers
that may be involved. Because PSE strategies seek to influence multiple factors and levels, it may be difficult
to measure PSE changes.

To plan, develop, and implement PSE change strategies for disease prevention and health promotion, it may be
important to:

Engage partners, stakeholders, and community members in the early stages of program development.

Understand the needs of the target population to identify appropriate PSE change strategies.

Use health impact assessments to demonstrate the rationale for PSE changes.

Provide education to the individuals (i.e., healthcare providers, administrators, or teachers) and
organizations (i.e., healthcare facilities, worksites, or schools) who will be involved in implementing PSE
changes.

Foster partnerships and coalitions to support broader reach and sustainability.

Ensure enforcement of new policies.

Ensure regular review of PSE changes to evaluate effectiveness and impact on population health outcomes.

Health
in All Policies: Strategies to Promote Innovative Leadership
Document
Provides tools – talking points, strategies, stories, and other information – for supporting the implementation
of a Health in All Policies (HiAP) approach in policy and program development.Organization(s): Association of State and Territorial Health Officials (ASTHO)
Date: 1/2013

Influencing Policy Development
Website
This toolkit provides guidance for bringing about policy change in organizations and communities.Organization(s): Community Tool Box

Power of Trails for
Promoting Physical Activity in Communities
Document
Describes how trails are used for physical activity and the specific characteristics of trails that attract
regular users among various populations.Author(s): Troped, P.J. & Whitcomb, H.A.
Organization(s): Active Living Research
Date: 1/2011

The Rural Health Information Hub is supported by the Health Resources
and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)
under Grant Number U56RH05539 (Rural Assistance Center for Federal Office of Rural Health
Policy Cooperative Agreement). Any information, content, or conclusions on this website are
those of the authors and should not be construed as the official position or policy of, nor
should any endorsements be inferred by HRSA, HHS or the U.S. Government.